Sedation & Nervous Patients

There are three different levels of intravenous sedation: ‘minimal’, ‘moderate’ (sometimes also called conscious sedation) and ‘deep’ sedation. However, the levels are not precise and depend on how sensitive a patient is to the medication used.

Your seditionist or dentist will discuss with you the types of sedation suitable for you – there are different types of sedation available for dental treatment for adults and children. They will explain what will happen during your treatment and any risks. It is important that you carefully follow any advice and instructions that they give you.

The main differences between sedation and general anaesthesia are:

• your level of consciousness
• the need for equipment to help support your breathing
• possible side effects.

With minimal and moderate sedation, you feel comfortable, sleepy, and relaxed. You may drift off to sleep at times but will be easy to wake. With general anaesthesia, you are completely unaware and unconscious during the procedure. Deep sedation is between the two.

Intravenous sedation is when a sedative to relax you is injected into your bloodstream using a small plastic tube (also called a cannula) usually placed in a vein in your arm or hand. Seditionists are trained to give the right amount of sedative and manage any side effects. Your sedationist will stay with you during your treatment and monitor your breathing and oxygen levels.

• Sedation works quickly, and the dose can be adjusted so you get just the right amount.
• It allows you to be relaxed during your treatment. You may not remember much about your treatment afterwards.
• It usually has fewer side effects than a general anaesthetic.
• Recovery is quicker than after a general anaesthetic, so you can usually go home within an hour or two of your treatment if you feel well.

• A general anaesthetic: you will be fully unconscious throughout and will have no memory of the procedure.
• Local anaesthetic without any sedation: you will be fully awake during your treatment but will be comfortable.

You can discuss whether there is the option of sedation for your procedure with your dentist at the time of assessment. If it hasn’t been offered, you can always ask to see if it is possible to have it. If you are at higher risk from existing medical conditions, your dentist will discuss the options with you. You can then agree together the best option for you.

• If you have people that you look after, for example children or older people, you will need to plan for someone else to look after them until the day after the procedure.
• A capable adult will need to take you home by car or taxi ideally – using public transport is not advised after sedation. As the effects of sedation can last up to 24 hours, they should stay overnight to look after you.
• Take all your medicines to the dental practice with you, including any inhalers and any over-the-counter medicines you take regularly.
• If you have an illness or a cold, or you are pregnant, please contact your dentist, as it may not be safe to have sedation. Your treatment may have to be rearranged.
• Let your dentist know at your assessment appointment if you are breastfeeding.
• Remove all makeup – including nail varnish and jewellery – before coming to the practice. You may wear a wedding ring.
• Bring some loose clothing, such as a fleece, to keep you comfortable and warm.
• Wear flat shoes that are easy to put on.

The dentist/sedationist/nurse will give you exact instructions, including when to stop eating and drinking. For moderate and deep sedation, you should stop eating four-six hours before your treatment, but you may drink normal amounts of ‘clear fluids’ up to two hours before your treatment. Clear fluids include water, diluted juice (no bits) and black tea or coffee. Try not to stop eating or drinking for any longer than this. For minimal sedation, fasting is often not required, but it is important to check exact instructions with your dentist. If you have diabetes, you should ask for specific instructions about when you should take your diabetic medication and stop eating food.

You will usually change into a gown. When you go to the procedure room, your sedationist will attach some monitoring equipment to you.

The equipment used will usually include:

• a blood pressure cuff on your arm
• stickers on your upper chest to record your heart rhythm
• a clip on your finger to measure your oxygen levels
• a thin plastic tube that measures the amount of carbon dioxide that you breathe out. This is usually attached to an oxygen mask.

• The sedation is given through a drip (cannula) which is put into a vein in your arm or the back of your hand. More sedative can be given if you need it during the procedure.
• You will have extra oxygen to breathe from a plastic tube sitting just inside your nose, or through a face mask if necessary

This will vary between people, depending on how much of the drug they are given. In mild and moderate sedation, you usually feel pleasantly relaxed.

When we asked some patients what it felt like, some answers were:

‘I felt very spaced out and dreamy.’

‘I thought I had been awake during it all, but I must have drifted off at times as suddenly it was an hour later.’

‘I felt really relaxed and happy.’

‘It was weird – I felt very detached from what was happening around me.’

• If you have light or moderate sedation, you can usually go home within an hour of your treatment.
• As previously mentioned, a capable adult will need to take you home by car or taxi – ideally not public transport – and remain with you overnight. If you have not organised for someone to be with you after treatment, your treatment may need to be postponed.
• Sedation may make you unsteady on your feet. Please be careful on stairs and have somebody with you if you feel unsteady.
• Your ability to make decisions and judgements may be affected for up to 24 hours after your treatment, so you should not make any important decisions during that time. You should avoid posting on social media/public forums too.
• You should not return to work, look after dependants, drive, cook or operate any machinery for 24 hours as it may take this length of time for the drugs to leave your body.
• You should not take any alcohol or sleeping tablets for 24 hours after the procedure.
• Your sedationist/nurse will give written instructions about further instructions to follow at home, including what to do if you are concerned or feel unwell
• The sedationist/nurse will give you a contact telephone number to call if you feel unwell at home.
• If after the procedure you are concerned, feel unwell, or cannot find the dental practice emergency contact number, you can call your GP, ring 111 or go to your local accident and emergency department with a capable adult if necessary.

In modern sedation, serious problems are uncommon. Risk cannot be removed completely, but modern drugs, equipment and training have made sedation much safer in recent years. Seditionists take a lot of care to avoid all the risks outlined. They will be able to give you more information about any of these risks and what they do to avoid them.

• Your breathing rate may become slow. This is particularly common in deep sedation, but is a risk whenever sedation is used. Your sedationist is skilled in monitoring you and can support your breathing if required.
• It is very common for your blood pressure to drop by a small amount, but your sedationist is trained in treating this too.
• It is very common to be left with a small bruise where your cannula was placed.
• Feeling sick or vomiting is uncommon.
• There is a rare risk of stomach contents going into your lungs. It is important to follow the instructions for eating and drinking to keep this risk very low.
• Any allergic reaction to the sedation drugs is very rare.

• It is very common to feel drowsy and less steady on your feet. You may be at higher risk of falling, especially if you are elderly.
• It is common for sedation to affect your judgement and memory for up to 24 hours.